Kirsner J B
Department of Medicine, University of Chicago, Illinois.
Dis Mon. 1991 Nov;37(11):669-746. doi: 10.1016/s0011-5029(05)80013-6.
Once regarded as medical curiosities, ulcerative colitis and Crohn's disease have achieved a remarkable change in status recently and today are among the more compelling of all human illnesses. The cause(s) of inflammatory bowel disease (IBD) are not known. Genetic, environmental, microbial, and immunologic factors are involved, but the precise mechanisms are obscure. The incidence of ulcerative colitis is relatively stable, while Crohn's disease continues to increase in frequency. In 10% to 15% of patients, it is hard to differentiate between ulcerative colitis and Crohn's colitis, however, problems with diagnosis usually resolve with time and repeated examinations. In part I of his two-part monograph on IBD, Dr. Kirsner addressed the nature and pathogenesis of the disease. Increased study of ulcerative colitis and Crohn's disease in recent years has generated new knowledge regarding their etiology. Part I focused on microbial, immunologic, and genetic mechanisms of, and the inflammatory process involved in the disease. In this part, Dr. Kirsner deals with the clinical features, course, and management of IBD, based on the author's 55 years of experience with these problems and supplemented by critical examination of the recent (1988-1990) literature. Particular attention is directed to the symptoms and physical findings of ulcerative colitis and Crohn's disease. The laboratory, radiologic, endoscopic, and pathologic features, and the many systemic complications. IBDs are mimicked by several enterocolonic infections and other conditions making differential diagnosis necessary. Inflammatory bowel disease in children and the elderly conforms to conventional clinical patterns modified by the health circumstances of the respective age groups. Because the cause of IBD has not been established, current medical therapy is facilitative and supportive rather than curative. The principles of medical treatment are approximately the same for ulcerative colitis and Crohn's disease. Treatment emphasizes a program rather than a drug and also considers the individuality of the therapeutic response. A clearer understanding of dietary and nutritional needs, including hyperalimentation and electrolyte and fluid balance, aids treatment. Antidiarrheal and antispasmodal preparation and sedatives are prescribed for symptom relief. The bowel inflammation is controlled with sulfasalazine or the newer 5-amino-salicylic acid (5-ASA) compounds, antibacterial drugs for complications of Crohn's disease and IBD, adrenocortical steroids, and the immunosuppressive compounds 6-mercaptopurine (6MP), azathioprine, and cyclosporine, as determined in each patient. The surgical procedures available for treatment of ulcerative colitis include total proctocolectomy and ileostomy or ileoanal anastomosis.(ABSTRACT TRUNCATED AT 400 WORDS)
溃疡性结肠炎和克罗恩病曾一度被视为医学上的罕见病，但其地位最近发生了显著变化，如今已成为所有人类疾病中更引人关注的疾病。炎症性肠病（IBD）的病因尚不清楚。遗传、环境、微生物和免疫因素都有涉及，但确切机制仍不明确。溃疡性结肠炎的发病率相对稳定，而克罗恩病的发病率仍在持续上升。在10%至15%的患者中，很难区分溃疡性结肠炎和克罗恩结肠炎，不过，诊断问题通常会随着时间推移和反复检查而得到解决。在其关于IBD的两部分专著的第一部分中，柯斯纳博士探讨了该疾病的本质和发病机制。近年来，对溃疡性结肠炎和克罗恩病的研究增多，产生了关于其病因的新知识。第一部分聚焦于该疾病的微生物、免疫和遗传机制以及所涉及的炎症过程。在这一部分中，柯斯纳博士基于作者55年处理这些问题的经验，并辅以对近期（1988 - 1990年）文献的批判性审视，论述了IBD的临床特征、病程及治疗。特别关注溃疡性结肠炎和克罗恩病的症状及体格检查结果、实验室检查、放射学检查、内镜检查和病理学特征以及许多全身并发症。几种肠道感染和其他病症会模仿IBDs，因此需要进行鉴别诊断。儿童和老年人的炎症性肠病符合由各自年龄组健康状况所改变的传统临床模式。由于IBD的病因尚未确定，目前的药物治疗具有辅助性和支持性，而非治愈性。溃疡性结肠炎和克罗恩病的药物治疗原则大致相同。治疗强调一个方案而非一种药物，同时也考虑治疗反应的个体差异。更清楚地了解饮食和营养需求，包括胃肠外营养以及电解质和液体平衡，有助于治疗。会开具止泻、解痉制剂和镇静剂以缓解症状。根据每位患者的情况，使用柳氮磺胺吡啶或更新的5 - 氨基水杨酸（5 - ASA）化合物、用于克罗恩病和IBD并发症的抗菌药物、肾上腺皮质类固醇以及免疫抑制化合物6 - 巯基嘌呤（6MP）、硫唑嘌呤和环孢素来控制肠道炎症。可用于治疗溃疡性结肠炎的手术方法包括全直肠结肠切除术和回肠造口术或回肠肛管吻合术。（摘要截选至400字）
